HomeMy WebLinkAbout17-18384 CITY OF ZEPHYRHILLS
, � 5335-8TH SfREET ,
' ' (813)780-0020 18384
BUILDING PERMIT
PERMIT INFORMATION ' � LOCATION INFORMATION
� Permit Number: 18384 Address: 7329 APPLEGATE DR
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: ALPHA VILLAGE
Est. Value: Parcel Number: 35-25-21-005A-00000-1020
Improv. Cost: 10,000.00 � OWNER INFORMATION �
Date Issued: Name: RIVERA, JEREMY& BOBBIE
Total Fees: 247.50 Address: 7329 APPLEGATE DR
Amount Paid: 247.50 � ZEPHYRHILLS, FL. 33542
Date Paid: 4/20/2017 Phone: (813)997-5208
Work Desc: CONVERT GARAGE TO BEDROOM /UTILITY RM
CONTRACTOR S APPLICATION FEES
HOMEOWNER BUILDING FEE 127.50
HOMEOWNER ELECTRICAL FEE 60.00
HOMEOWNER MECHANICAL FEE 60.00 ��
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, Ins ections Re uired
FOOTER 2ND ROUGH PLUMB MISC INSULATION CEILING
FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection. �
NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
' improvements to your properly. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans,Specifications Must Accompany Application.All work shall be pertormed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
� 1 ` `�-
CONTRACTOR SIGNATURE ' PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
� Building Department
Date Received,
Phone Contact for Permitting ; _
Owner's Name '�)� �J 1��-l��.� Owner Phone Number �t 7 7"5
Owner's Address ` �� � LQ " � Owner Phone Number , ���- ✓� a
Fee S1mple Titleholder Name Owner Phone Number �� a�r�i-g o0
Fee Simple Titleholder Address
JOB ADDRESS �Ct-`��- �--� �-�V�v��- LOT# �
SUBDIVISION ( � l L1 ' PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED e � NSTALLSTR 8 -REPA RT Q SIGN Q � Q DEMOLISH
� PROP.,OSED USE Q SFR Q COMIVI 0 OTHER
TYPE'OF CONSTR'l1CTION Q BLOCK • Q FRAME 0 STEEL Q I
' tiq
DESCRIPTIOM"OF WORK �Yl�f'o� Yl C •� �,,i c� . � {�j �\�pCJ-y� �-�-�L�-� �'��
BUILDING SIZE SQ FOOTAGE� HEIGHT •
QBUILDING $ �b �� � VALUATION'OF TOTAL CONSTRUCTION
•_QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
OPLUMBING $ � /�OC
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION D ���/��;�� �C
Q,GAS Q ROOFING Q SPECIALTY Q OTHER (f/
� FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO C �� ,
�
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BUILDER � �COMPANY ��aL��"�,
SIGNATURE � ���-/�� ��� REGISTERED Y`/ N FEE CURRE� Y/N
Address �jG-'�-�2. �S ��p�� -License.# �
- ,�
,- 'ELECTRI,CIAN ,,, g �/�i � COMPANY
SIGNATURE - �� REGISTERED Y/ N �FEE CURRE� Y/N.
' Address - License# �" �
P.CUMBE�;::: � �OMPANY- .
'SIGNATURE REGISTERED Y-/`N . FEE CURRE� Y/N I
Address , License# :
�'MECHi4NICAL' ,6 COMPANY
" SIGNATURE' " � ��
REGISTERED , Y/ N, . FeE CURREn , Y/N ,
Add�e"ss�•` - •• Licens.e.#
�:tk�'. _ ' .,. -.. . . _ .
:: OTHER` ��, , , ` , ' COMPANY � �
;"=SIGNATURE,�=•=:._ ^ ' -� • REGISTERED Y/.N FEE CURREK Y/N
` Address�- " License#
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;>.�RESIDENTIiAL�;�::':Attach'(2)`.Plot`:P.lans;'(2•):sets<ofBuililing�Plans;(1)=sefofEnergy'For'ms;R=0=Y11.Permit,fornew.construction, �
_ ;�•,.�';-�;.�:,•,.<:-_,:Minimum.�ten;(}1'0),wor.king;:days:aftersukimittal:date:�Required`onsite;Gonstruction Plans,Storinuirater�Plans w/Silt Fence installed,
=...- �Sanitary;FaGli6es;&r�ls;dumpster;_Site.WorkPermitfor;subdivisions/large:projects " `� ' �
`<COMMERCIAL Attach1(2)�complete"sets��of'Building Plans�plus a�Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
=__ Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
- San(tary Facilitles 8�1 dumpster,Site Work Permit"fo��all new p�ojects.All commercial requirements must meet compliance
, `:�SIGN�PERMIT "Attacti`(2)sets;�of-,EnglneeredrFlans:=��� -�:�� � ' � • ,
*"""PROPERTY SURVEY required for all NEW construction.
,..Di�ecttoris: ,=_K ..-.. .., ,.
-�' flll.out application completely.
Ouvner&-Contractor sign back of appllcation,notarized
°If over$2500,a Notice of Commencement is required. (A/C upgrades over$7500)
""'� AgenY(fo�'4h'e�contractor)°or°Power�of'Attomey(for'tF9e owner)would tie someone with notarized letter from owner authorizing same
.1:.
�?;OVER':THE COUNTER'rPERMIITING.�„_ (copy..of-contract-.required) '' ' - �
:-';Re�oofs if'shfngles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage)
,_,..
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Dr(vewrays-Not over Counter if on public'roadways::needs'ROW �
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NOTICE OF DEED RES7RICTIONS: The undersigned understands.that.this:permit may be..subject to r.deed;�resirictioh's .- ;-
vtrhich;may.be:more.restrictive;than-.Caurity cegulat�ons: The�uni�ei�signed,assumes`��esponsiEiil�ty':fa�`compliance��vin#h any'��`'��,�
applicable deed restrictions. �x„p-y>�;.%�, .;:�����;:
UNLICENSED. CONTRAGTORS AND' CONTRACTOR RESPONSIBIL-ITIES: If�tl�e sow�er=has�laiiecf�=a'��con#ractar or
contractors to undertake work, #hey,mayj be reguired to be�licensed�in accordance with.state and.'�local:,�egulatians:'x�-:if:�tlie�;1:��'�-
contractor is-not.licensed as rEquired'by�'law, both the owner�'and"confracfor-rriay�be��cited��fo�=a�.�misdemeanor violatio�� ,�;a�-
under.sta#e 1aw. �If the owner or intended,contractar are uncer#ain as to what ticens�ng requirements:;maykappiy_for;�%th;er.:;"w:;t
,:,,h,- ;�..� .,,,.:,
intended.wark,-they-are�advised to contacY the'Pasco Caunty"Buildir�g:lnspectiori`Division.=Licensing Section at 727=84:7= ��.
8049. Fur-thermore, i� the owner tias tiired`a cantractar�or eontracEorsf he�is advised to,~ihave #lie contrac#or(s)rsign."Y�.;.:
portions of the "cantractar Block" of this application.for.,which.they will be responsible:�.:lf:yb`u, as°�#fie'.�owner'sign'as`ftie" ��';�-
contractor, that may 6e an indication that�'he�is'not propePly ticensed and�is not'entitled to"permitting priyileges,in„�Pasco=,,,.;:,
Caun#y. �. . � . _ _� _;.. ...:�.�tsv.w���,
TRAN5PORTATION IMPAC7lUTILITIES•IMPACT AND RESOURCE RECOVERV�FEES:��The undersigned undecstands s „`�},i
that Transpartation tmpaci Fees and Recourse Recavery Fees.may�apply to#he construc#�on.of�new:6uilclings,:ctiaiige�o.f�'r"::;��°
use in existing buildings,, or-expansian;of.,<eicisting buildings, as specified in Pasco County Ordinance num6er 89=Q7 and `���:;ti�;
90-07, as amended. The�undersigned also,understands, thafisuch,fees,�as�.may�,b.e�.due, wrilfbe�identifed�afi�ttie_�:tiErie�:af���:�;�=z::��
ermiftin �It is further understood ttiat Trans�orkation im act�Fees��•and Resource=�Recove. Fees must be aid rior to' ''�`
p 9• ' P P ry .� p p.� .� :. _ �:
receiving a "certificate of-occupancy" or�final.,power release. !f tne project does not:invalve a.certificate of occupancy�:orx,4=='*�: ,
final pawer release;:the.fees must be,paid prior to perriiit issuance. FurtFiermore, if Pasco�Counfy Water/S.ewer,�impact=,<;.� ;<-
fees are due, tfiey must:be:paid prior�to permif issuanee in`accordance°with'applicabl�e,P�asco'Coun#y ordinances. � "
CONSTRUCTiQN�!�#EN~I:AW(Chapter 713, Florida Statutes,as amendecf}: If valuation of vsrork is$2,500:0.O..ar.:mor;e;;_i�.,,,; '
certify that i, the applicant, have been--provided with�-a copy__.of-#he "Florida Construction�'Lienr�Law=Homeowner's A���
Proteckion Guide"-prepa"red�bjr"the Florida Department of Agrictalture snd Consumer.Affairs. If the applieant is.s.arrieone.., .�
other#han the°awner�,.(;certify that.l_haVe obtained a copy of the.above"descri6etl document-and pramise;in�goo,d`fa�itti�to";�. '
deliver.it to:the;"owne�':prior;fo��commencement. °
CONTRACTt}R'SItJVI1NER'S AF�IDAV.1T::r;1,cer#ify that ali the inforr»ation in this application is accurate and�tiiat alt`-vuork
will be done in compliance with all applicable laws regulating canstruction, zoning�and land-development. Application.is
hereby made to obtair�,,a..permit_.ta-do..,work--and instaliat�on.:as�•indicated. E�cert�fy that no-work or .ins#allat'ion�has
aommenced prior- to issuan'`ce of a p.ermit and��that all work will be performed ta meet standards of all laws regula#ing
construction, County and City aodes, zoning regulations, and land developmen#�regulations�in.the jurisdiction. -t,also �
certify that 1 understand that#he regulations af other government agencies may apply ta the interided work, and that it is �
my responsibility#a identify what actions I must take to be in compliance. Such.agencies include but are not limited^to: "
- ,Department of Enviranmental::Rrotection-Cypress Baylieads, Wetland Areas and Environmentally"Sensifive �
Lands,Water/Wastewater 7reatment. '
- Southwest Flor9da Water Management District Wells, Cypress Bayheads, Wetland Areas, Altering =
Watercourses. ,
- Army Carps of Engineers-Seawalls, Dacks, Navigable Waterways.
- Depar#ment of Health & Rehabilitative ServiceslEnviranmental Health Unit Wells, Wastewa#ec Tceatment, - ,
Septic°Tanks.
- US Environmental Protection Agency-Asbestos.abaternent, s�t
- Federal Aviation:Authority-Runways.
I understand that.the foAowing restricfians apply to the use of fill:
- Use af fll is not allowed in Flaod Zane"V"uniess expressly permitted.
- If the fill material is to be used in F'lood Zone °A", it is understood that a drainage plan addressing a
"compensating volume"will be submitted at time af permitting which is prepared by a prafessianal eng�neer '
licensed by the State of Florida. '
- If the fil! ma#erial is ta be used in Flood Zone "A" in connection with a permitted building using stem wall
consfruction, 1 certify that fill witl be used only to fili the area within the stem wall.
- If fill material is to be used in any area, I certify that use af such�fil! will not adversely a�feat adjacent
prape�kies. If use ti�fill is found to adversely affect adjacent properties, fhe awner may be cited for vio[at�ng
#he conditions of.the building permit issued under.the attached permit.appliaation, for lots�less than one (1) � '
acre which are elevated by fiil,an engineered drainage plan is requ�ced. �
1f I am the AGENT FOR THE OWNER;-I promise in good faith to inform the owner of.the permitting canditians set forth in
this affidavit prior to commencing construction. I understand that.a separate permit may be required for efectrical v►rork,. _
ptumbing, signs, wetls, paols, air conditioning, gas, o� otFier�installations nat specifically included in fhe app(ication. A., ��
permit issued shall'be construed�to be a license�ta proceed�with the work and nofi as authority.to violate, cancel, alter, ar '
set aside any prav�sions af the�fechnEcal�codes, nor shall issuance of a permit preven#the 8uilding C}fficial from theceafter
requiring a correction of errors in plans,�_construction oc violations of-any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within sin months of permi# issuance, or if work autharized by
#he permit is suspended or abandoned�for a�period..of six(6)mo,nths after the time#he work is commenced. An extension ' �
may be requested, in'writing, frbm the Buildirig Offi�ial for a period not to exceed ninety (90) days and will demonstrate
jtast�able cause far the e�ctension. .If wark ceases forninety{90)consecutive days,the job is considered abandoned.
WARNlNG TC? QWNER: YDUR EAl1.URE TQ REGQRD.A.NU.T.tCE OE CQMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE'FOR IMPROVEMENTS�TOYO.UR�PROPERTI(:. IF YOU>>INTEND T0 4BTAIN FINANCING, CONSUL.T.___ _. _ _
-- - - lNI�'H Y+�UR`�:EN[D�R OFt AN-�i,TT�I�N�I BEFORE RECOR�IIN�YCIUR-NOTICE OF�COIVIIVlENCEMENT.
FI.ORIDA JURAT(F.S.197.03) . . '
OWNER OR ACaENT�_�~'�- �}"'� CONTRACTOR �� `"'- v��-^" �--"'�
Subscribed and sw m ta{or,affirmed before rne thls Subscribed and sw� ta(ar afli ed}be re m this
by �`oY�� �o�,���.�"c� by �c�bb��� ������--
Who is/are persanally known to me or has/have produced � Who is/are personally knawn to me or haslhave produasd
as ider�tification. ,� �= as identificat�on.
Motary Public Notary Publlc �
Comm9sslori iVo. Commisslan Na.
Name of Natary typed,prir�ted or stamped tVame at tVatary typed,pr3nted ar sfamped
�' DISCLOSURE STATEN�tdT FOR OWNER
CITY OF �BPIiYRIiII�LS BIIILDING DEPARTMI'sN'�
I, �`{"�ht )� ti�t..�-��`�C�'-�_ � have read and fu11y unders�and aad
agree to the pravisious of thie iastrumeat.
The undersigaed states and affirms that h� ar she is desirous af caastsucting,
reaovatiag, addiag ta or reroofiag his ar h�r owu domicile, that h� or she
ac�ual3.y occupies, or wil.l aceupy by said domicile, an� same is not fax
reat, lease or sale. That he ar she shall camply with the followia� coaditiaas:
I. That the owaer aad he or she aloae �hall act as the builder far all phases of
construc�ioa.
2. That the awner wiZl compZy c,Tith all grovisioas of the City of Zephyshills
ordiaaaces aad cades pertiuent to the buildiag.
3. Tha� ia the eveat various phases of conetructioa are subeoatrae�ed, he s,ri31
engage aaly properly licensed subcontractors aad will p�rsaaally supervi�e
such work.
4. Tha� in the eveat the Suilding Zasgeator sha2l requir� carrectians to be made,
the owaer wi11 aseume full respoasibility to iasure they are made, and upon
completion will call �or a reiaspect3an before pzoaeediag wa.th the builditig.
5. Tha� th� owaer shali a�sume fu11 respoasibility for the coastructioa and will
aot expeat supervisioa of b.is work from t�he City o� Zephyrhills Building
Degartmeat.
6. That prior �o fiaal iaspectiion aay additioaal fees, iaaludi�ng r�iaspectioa
fees, muat be paid ia full. A wzittea reguest frpm this af�ie� shall
constitu�e aa official aotiae to pay additioaa�l fe�es.
7. Tha� the owaer shall comply with all City, State aad Federal law� in regard to
social security, workman's aompensation, lien laws, eta. , where applicable.
8. Tha� the owaer shall camply with all the safeGy cades 3.ssued by the E'lorida
Iadustrial Commissian. �
9. State law requires conetruction to be doaxe by liceased contractars. You have
agplied far a permit uader aa exempGion ta th�t law. The exemptioa allows
you, as th� awa�r of your property, to act as youx owa coatractar wi�h certaia
zestrictioas even though yau do not Szave a license. Yau must prcvide direct
onsite supervisioa af the coastruetioa yourseZf. Yau m�.y build ar improve a
one-�'amily or two-tamily resideace or a tarm outbuildiag. You may also build
or 3mprove a eomme=cial buildiag, provided yaur costs da aot exceed $?5,004.
The build3ag ar reeideace must b� £os yout owa use or accupaacy. It may aot
be built or substsatially improved for sale or le�se. zf you sell or leaee a
building you have built or substaatially i.mpsov�d yourself withiss 1 year aftes
the coastructioa is complete, the law will presume that you built or
substaati.ally improved if faz sa�.e or I.ease, mhieh is a violatiaa of �his
exemptioa. Yau m�y aot hire an ualicens�d person to aaG as your contractor or
to supervise people working oa your buildiag. It is your respoasibility �o
ma3ce sure tha� geag�e emglayed by you have Iicenses rec,�uired by stat� 2aw aad
�y cauaty or municipal liceuaiag ordiaances. You may aat delega�e the
responsib3.lity for supezvisiag work to a I.iceased contractos who is aot
licensed �o perform the work beiag daae. Aay persaa workiag on your building
who ia nat liceased must wor7s under your direct supervision and must be
employed by yau, whicl� meaae that yau �►us+� a�au�t F'.I.C.A, and withhalding tax
and provide worker�' compensatian for that employee, a1Z as prescribed by law.
Your constzuetioa must comgly wi�h a12 applicab2e I.aws, ordis�aac�s, buildiug
codes, aad zo�.iag regulatioas.
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OWNER S SS6NP.�URE
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City of Zephyrhills
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Serv�ce Requesf # 5633 No Permit
Date 4/4/2017 4:14:OOPM Assignee Bacon,Joel
Status Open Department Building
Schedule Taken By Boges,Jacqueline
Closed Date Priority
Location 7329 APPLEGATE DRIVE
Feature
District
Caller code,enforcement Address 5335
Home Phone City/State/Zip ,
Work Phone Caller Note
Cell Phone E Mail
Description
ride through found home closing in garage no permit- owner phoned 4/4/17 I asked for them to turn in what is
being done for permit
Contact Notes
Date Time Made Note
April 4, 2017 Paae 1 of 1
yj : �J a /� �/,�IL //A .
� /1 y�(, `[..�Y 1 �A
vr`S, �/
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By order of the �uilding Official: �ViCC"Zam.,�. �urgess
All �uolding, plumb�ng, electrical and rnechanical work
shall cease at the belovv mentioned property.
Address: � 3 a� � QP Lf G A 1� 17SZ
Date: � - 3 — i 7
Code Enforcernent Officer: � ��C� 1��
Contact.the
Zephyrhills �uilding Depa�tment
5335 - 8th Street
�13-780�00a0
v ' ' " ` � IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII ',
2017055847
' _ Rcpt:1854701 Rec: 10.00 ,
DS: 0.00 IT: 0.00
04/13/2017 J. R. , Dpty Clerk �
. �PRULR S 0'NEIL,Ph D PRSCO CLERK & COMPTROLLER�
NO�'ICEOFC�IVl1VdENCEMEIV�' 04/13/2017 02:51 m 1 of 1
' ', OR BK �52� PG 23
PermitNo. -- - -- -- -
Property IdemiSc�tion No.
Tf�UrTDEERSIGNED hereby give iaSnrms yon thet the improvement wip be made to certaia real pmp�rty�end'm eccordence with
Section 713.13 of the Florida Stahrtes,the following informetlon is provided m thi,y N��OF COM2VII�NCEMENT.
1.Descriptionofproperty(legaldescriptfon) � oZ.'`">—a� —��'(/�- —O��—�C7 �
a)Street Address: (� � �
2.Qeneial description ofimprovemeats: �c-�,,�,
3.Owner Info�mation
a)Name and address: � ` ti( J �
• b)Name aad address of fee simple title6older('if pther than aqmer) �����5
c)Intarest ia propwty .
4.Contractor Info:msbion
. a)Name aad add�ess:. ��'\-¢_ C+-q �r-,�7 y� ✓•
b)Telephone No.: Fax No.(Opx)
5.5�ety InformetIon .
a)Natae and'eddress:
b)Amount ofBond:
c)Telephone No: ' Fax No.(Opk)
6.Lender
a)Name and address:
- Phone No.
7.Tdentity of petson within the State of Florida dealgpeted by owner upon whom notices o�oflier doc�ents mey be served:
a)Name end address: •
b)Telephane No.: � Fax No.(Opt,)
8.In addition to himsel�oWne�designates tlie followirig person to tec.�iye a cppy of ihe�iepor's Notice es�provided'm Section
713.13(1)(b),Florida S�s:
a)Name and addr�ss: •
b)TelephoneNo.: t '� ' FexNo.(Opt.)
9.Fxpuation dete of Noflce of Commencemept(the expiraetiioa date is oae year frot»the date of record'mg m�ess a diffeiant datc is
specified):
'WARNIlYG TO OWNER: AhIY PAYA�lENTS I�fADE BY THE OWN$12 AFPEii TEE�RPIRATIOPi OF THE PIOTICE OF
COMMENCENiEN�'t�RE COIVSID�RED INlpgOPER PAYIIIENI'S UNDER CgAPTEg 713,PART I,SECP[ON?13.13,
FI:ORIDA STATC)TES;�ND CAIiT RESUI.T IN YOUR PA7CAT�TWICE FOR IIV�ROVEAIENTS TO YOTJIt PROPERTY.
A NOTICE OF COIi9YLENCEMENd'MUST B�RECURDED A1VD POSTID ON THE JOB S1TE BEFORE TAE F[RST
INSPEC�'ION. IF YOU IIVTEIVD TO OBTAIN FINANCING,COWSULT YOU�t LENDER OIt AN A,TTQRNEy gEgpgE
COMMENCiNG WOEK OI;RF,CORDING YOUR 1VOTICE OF COMNdENCEMENT.
STATE OF FLO rs�vu ( ^
COUNTYOFPAS �` � PATWCIALJOHNSON i
i M.YCOMMISSION#FF185847 ,SI ofOwnermOwna'eA oScu/pirector/pumc/M�ege
��aF�o�°EXPIRES December 28,2018 ���, � 1� �`v Q���
PnarName
The fozegoing insfi�ent wav aclmowledged kefine me this /�dey of_ flPR f t� . .20�7�by �C i3.�( .
�'G /�f V�RA es (type ofeuthorhy�ag.officer,trustee,attorney
m fact)for (qeme ofpazty on behalf of whom instc�e�was executed).
-�/- �- - 0�, •� -- -- -- - — ------ - -- -- --
- - - -- PeisonallyKnown—_ORProducedIdenHScetion_ N --S�--ahao�o�(;-p� ok.
TypeofIdwtificationProduced !�.t. Name(prmt) PAT�2rClA L•�dH1�1S'ORJ '-
Vertfication pursuent to Section 92.525,Florida Stawtcs.Under pmaltles of perjury,I declare ihat I have read the finegomg end thaz
the facts stated in it aze true W the best of my lmowledge end befie�
FORMS?lOC,rnd]Drt/ Signnnue nfNehael pveoy 3igUng Above
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City of Zephyrhills
BUILDING PLAN REVIEW COMME�TS
Contractor/Homeowner: �
�,�/�'. E%� �v�-�
I�ate Received: __�1�.�i�
Site: `7
Permit�'ype: • �
Approved w/no comments:❑ Approved w/the below comments; ❑ l�enied�y�the below comments: p
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C�1��'�`� �✓ �d�l� C/���� ��
�is c�mment eet s 1 b kept with the per�it and/or plans. ,
,�
� � �
�,�`y��7 �
' alvin wi — 1 Examiner Date ontractor and/or Homeowner � " �
(Recluired when comments are present)
From:Royai Oak IVursing Genter 352 567 2250 OSl231201? it0't #09S P.UO2l003
FORMS
FLORIpA BUIl.OINC�COD�,ENERGY C8lJ5ERVATtCtt�
F4RM 402-2410 Res}denUa!8utiding'1'hermat Em*atape Apptoacf� ALi.CLIMATE ZdNES
Scope:Compiiance with Section d02 of the ftorlda 6ailding Gbde,fr,eryy Conservation shait be demonstrated by ihe use�i Form 402 for Single-and mul�pte�tamiy residences o!three
stoass csr tess in heigM,additions to��sEiog restdentia!bv9tdtn�s,renovatfpns 2o existfng resfdentiai�uiidings,new tseating cooting aod water heating systems in exlsttng buiidings as
appitcaWe.7o comply,a building must meet or exCeed a1t ot Ihe enargy efficiency requiremeRis on Tab�e 4Q2A and all appBca6le mandatory requfremetttS&Uittttl2riZCd IO TObie 4629 o{this
tarm.ii a huiiding does not compiy wiih ihis method or Atternate Form 402,it mEy s1i�l comply under 5ectinn 405 of the fJorida Buildirtg CoGB,Ene�gy CnnservaGarz.
PROJECT NANiE: `L{:SY�V tts'{' C^�G'.�Sf�S�� BUtLDER: r • Yl.rj �`C..�C � �4�' o
nrao nanR�ss: 7 3��p �o. c.�l�.. �Rrairn�a� � !l!S
�, o��rc�:
OWNER�,�. �,�� PEHMl4'81p.: �� RISDtC71QPi tZO.:
Geaenl InxUucttons:
1 New construction which incorporatas ar�of ihe foltowfig feetures cannot compy using tfiis method:gfass areas in excess oi 20 pece�ot Conditioned floor area,aleeiric resistance
heat and air harsdiers incated i�atiics.Add�ifons 580D sq.it.,renovaltans and equipmentchangeouts me�compiy 6�i ihis method wiih exceptions giren.
�I 2.Fil1 iA a!!the BpStlica64e spaces o!1hs"7o Be Instakied°colmm�on 7abie 442A with the intorntattan requested.AI!"To Be lnsts(1ed"vaiass must be eqasl to or mare efiticient than ihe
' tequired leveis.
i 3.Cornplete page 1 based on the"Ta Ba tnsteiled"caiumn intormation.
' 4.Raad the requ�remeni&of Tsbie 4Q26 arrd check each box#a ir�d�cate your t�terrt to wmpty wrih ait appflcable items.
I5.Fiead,sign and date tbe"Prepared 8y"ceRfilcation siatert�erri ai the�oitom o!page 1.The otvner ot ownets age�t musi alsa sign and dafe the farm.
j Ptease prartt CK
� 4. New canstruction,add'it(on,or existing bu3lding i. �. �� ;��,;v�t�,
2. Stngle-femity dstaehed or muitipie�family ettached x, it 1 .c1�' �� �
3. �f muilipte-tamiry-No.of untts covere�d by this subrnission �,
4. is ihis a warst oase?(yeslnaj q, Y1+3-�
5. Coedltloned floor erea(sq.ft.) 5,���,�'T
6. Glasc iype and area: ��
a.Udaator ��- �
b.SHGC 8b.
c.Glass srea fic. Co sp,ft.
7. Percentage of glass ta fioor area 7, ,� �
8. Floar type.area or perlmeter,and insulation:
a.Slab-on-grade(R value? 80.Ra lin.ft
b.'4Vaod,raised(R-value) Bb.�I= sq.1t.
c.Wood,cammon{R value) g�,R�_ yq,�.
d.Concrete.raised(R-vslue) gd-R=� �R.ft.
e.Concreee,cammon(R-value) 8e.R= j����stl.fi.
9. weU type,area and irisniatian:
a.Ezreriar. I. Masomy(7nautetion R-value} 9a-1.R- Ea l�i� sq.}G
2. Waad frame tlnsulation R-value} g$.2,A= 1�_ 5(} sq.f�
b.Adjacent: I. Masonry{Insuladon R-vetue� ' g�.�, ���_ �(p� �,(t,
2. Wood hame(lnsulation lt-ualue) gb.2,�� 1'�j �sq,i#,
y0. Ce!ling type,area and lnsuteiion:
s.Under auic{Insuiation R-va�ue} y pa,p_ '�'jb _�,n,���
� b Susgte assembiy(insulstion R-value} �qy p� �.�
11, Air distrlbut#un system:Duct Insulat�an,loc,atton,On
�, a.Duct lacation,insuladon 11&. R� �. +�._„ , „l,�
b.AHU location 'lfi�. {���iG
�
c.Qn,Test reporc attached(<0.03;yeslno) 1 t+C.Test repali a#taehed? YtS�
,2. c�o«Rg s�fi: e�au c�
&.�,� 12a.Type:�e�,�� d�.
b.ESiciency 12b.SF.�iiCEER:
i3. Heating syatem: i3a.'f�+pe:,,,��vti'�AS�e{ ��
a.� 13b.HSPFlCOFtA�
b.Efiiciency
3A. HVAG sizing caicufatton:attached , .�q y� �
15. iiot water systam: �
a.'iype 15e.1'ype:
b.Efticiency
1bb.EF:
I 3�ereby ceRify ihai the plans anq apecitiwtion�covered 6y the cekulation ere In complfanee wrih the Rorlda Aeview ol pfars end spectticetioas covered Dy lhis ca1¢ulatlon indiratrs eamyllanr,�rrim ihe Florida
faerpy Code. fn0rgy Code.8sfor8 eonstructioa is eo 6. b n 71 be inbpected 1nr eompl�nce In
PAEPARED 9Y:�,��.'UfA'� ��''�'�.�' �{ ��Z SccorGanca w[th Section ff53.�8. .
DA7E: ' Y1$. d'(�� ��
COOE OFFICIAL'
!herEby Cert'r!y thatthis buildleD'ts In comp�ante with the�loriGa Enerey Godc �� �..
(YWNER AGEPIT: QAiE: QAiE:
C.4 2010 FLt}RIDA BUILDiNG Ct1DE--BNERGY CONS�RVATI4N